MCH Leads Health Equity Edition – In order to advance health equity for MCH populations, beginning January 2023, MCH Leads will feature trainees’ health equity-focused work. We look forward to highlighting trainees’ experiences supporting the health and well-being of vulnerable and underserved populations and communities. Also, their work assessing and addressing the underlying causes of health disparities–and their efforts to promote diversity, equity, and inclusion–ultimately improving MCH outcomes. In addition, we encourage trainees to reflect on how the MCH Leadership Competencies are applicable to their health equity-focused stories.
Niju Khoteja is a graduate student pursuing a Master of Public Health (MPH) in epidemiology at Saint Louis University. Niju completed her bachelor’s degree in public health and has a strong passion for community health. She has been active in youth-led organizations for over four years. Niju’s journey led her to a profound understanding of health equity, particularly through work promoting exclusive breastfeeding. Having worked with marginalized communities in Nepal as a Participatory Support Officer for WaterAid, she saw firsthand how public health interventions can empower individuals to demand their basic rights, from access to safe drinking water to improving menstrual hygiene. These experiences have reinforced her commitment to addressing health disparities, especially in maternal and child health (MCH). Currently, Niju serves as a Graduate Research Assistant at the Center of Excellence in MCHEducation, Science, and Practice at Saint Louis University. Niju is eager to continue her journey in public health, leveraging her skills and passion to bring about meaningful change and improve health outcomes for underserved populations.
The Importance of Exclusive Breastfeeding
Exclusive breastfeeding—feeding infants only breast milk for the first six months of life—has immense health benefits for both mothers and babies (World Health Organization, 2024). According to the World Health Organization (WHO), breastfeeding provides all the nutrients an infant needs during this period, protects against common childhood illnesses such as diarrhea and pneumonia, and contributes to the development of a strong immune system. For mothers, breastfeeding lowers the risk of breast and ovarian cancer, while also fostering a strong emotional bond with their child (Victora et al., 2016).
However, exclusive breastfeeding rates remain low in many parts of the world, often due to societal misconceptions (Rollins et al., 2016). Some new mothers feel pressured to switch to formula feeding or introduce solid foods prematurely, which ultimately undermines the infant’s health. Others face challenges like returning to work without supportive maternity policies that don’t allow parents to continue breastfeeding. These barriers disproportionately affect low-income women and women from marginalized communities, exacerbating health inequities (McFadden et al., 2017).
Advocacy Through Awareness Campaigns
Every August, the Rotaract Club of Kathmandu Mid-Town organizes awareness programs aimed at promoting exclusive breastfeeding. We noticed that many new mothers were unaware of the benefits of breastfeeding. To address this issue in an engaging way, we staged drama performances in maternity hospitals, creating realistic depictions of breastfeeding practices and emphasizing their importance. These performances were not only informative but also relatable, helping new mothers connect with the message on a personal level. The power of storytelling allowed the message to resonate more deeply with mothers. Mothers could relate to the performances, and received practical information and solutions to common breastfeeding challenges.
When the COVID-19 pandemic disrupted in-person efforts, we quickly adapted by recording dramas and sharing them on social media. This pivot allowed us to continue our mission to raise awareness, despite the challenges of the pandemic. The videos reached a broad audience, showcasing our commitment to promoting breastfeeding and highlighting the importance of adapting public health messages to meet people where they are, especially during times of crisis.
Mentoring the Next Generation of Public Health Advocates
Beyond raising awareness, I realized that true progress requires human connection and mentorship. My role in training new volunteers, coaching them on public health outreach, and navigating the complexities of community-based health initiatives was essential. Public health work requires collaboration; the success of our mission depended on building a team of advocates who understood not just the science behind breastfeeding but also the social factors at play.
Mentorship is about more than just imparting knowledge. It involves creating a supportive environment where individuals feel empowered to contribute their ideas, take initiative, and learn through experience. Mentorship helps foster a new generation of public health professionals who are passionate about health equity and skilled at addressing community health needs.
Promoting Health Equity Through Breastfeeding
Breastfeeding advocacy is, at its core, a fight for health equity. In many communities, exclusive breastfeeding rates are hampered by a lack of access to proper health education, inadequate maternity leave policies, and cultural norms that stigmatize breastfeeding in public (McFadden et al., 2017). Our efforts in promoting breastfeeding have always been rooted in the belief that every child deserves a healthy start in life, regardless of their background or circumstances.
Breastfeeding is a low-cost, highly effective intervention that can drastically reduce infant mortality and improve maternal health outcomes (Victora et al., 2016). Yet, without the proper support systems in place—both societal and structural—many mothers are unable to provide this critical form of nutrition for their children. In promoting breastfeeding, we aim to dismantle the disparities that exist in MCH and advocate for policies that support all mothers, regardless of their socioeconomic status.
Self-Reflection and Continued Commitment
My journey in public health has been one of continuous learning and self-reflection. Through my experiences, I have come to understand the importance of empathy, adaptability, and mentorship in creating meaningful change. Whether through face-to-face interactions or virtual outreach, I witnessed how meeting people where they are, listening to their concerns, and providing them with knowledge they need to make informed decisions is key for public health work.
As I continue my studies in Epidemiology, I am committed to advancing health equity through research, advocacy, and mentorship. Breastfeeding promotion is just one of the many ways we can create a healthier, more equitable future for all. By investing in breastfeeding education and support for new mothers, we ensure that children have the opportunity to thrive from the very start of life. I look forward to continuing this important work and contributing to a public health system that prioritizes the well-being of all individuals, regardless of their background or circumstances.
References
McFadden, A., Gavine, A., Renfrew, M. J., Wade, A., Buchanan, P., Taylor, J. L., Veitch, E., Rennie, A. M., Crowther, S. A., Neiman, S., & MacGillivray, S. (2017). Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database of Systematic Reviews, 2017(2). https://doi.org/10.1002/14651858.CD001141.pub5
Rollins, N. C., Bhandari, N., Hajeebhoy, N., Horton, S., Lutter, C. K., Martines, J. C., Piwoz, E. G., Richter, L. M., & Victora, C. G. (2016). Why invest, and what it will take to improve breastfeedingpractices? The Lancet, 387(10017), 491–504. https://doi.org/10.1016/S0140-6736(15)01044-2
Victora, C. G., Bahl, R., Barros, A. J. D., França, G. V. A., Horton, S., Krasevec, J., Murch, S., Sankar, M. J., Walker, N., & Rollins, N. C. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475–490. https://doi.org/10.1016/S0140-6736(15)01024-7
World Health Organization. (2024). Breastfeeding. WHO. https://www.who.int/health-topics/breastfeeding
